Thoracic Endometriosis Case Report

Dr. Mei-Ling Chen and Dr. Chia-Ying Li, at Show Chwan Memorial Hospital, Changhua, Taiwan, have reported a rare case of Thoracic Endometriosis that has been published in the New England Journal of Medicine.

Endometriosis is the condition wherein endometrial tissue is present outside of the uterine cavity, most commonly in pelvic structures such as the ovary, uterine ligaments, pelvic peritoneum, cervix, labia, and vagina. Thoracic endometriosis syndrome is the presence of endometrial tissue in or around the lung, which can result in recurrent hospitalizations and other complications.

Thoracic endometriosis syndrome consists of four distinct clinical entities:

• Catamenial pneumothorax
• Catamenial hemothorax
• Hemoptysis
• Pulmonary nodules

Thoracic Endometriosis is a rare and complex condition; therefore, diagnosis is often delayed or missed by clinicians. In order to avoid such issues and implement appropriate treatment, a high index of suspicion is essential in any woman of reproductive age or receiving hormone replacement therapy who is experiencing cyclical chest pain, dyspnea, and/or hemoptysis. As far as treatment is concerned, hormone therapy is a suitable first-line treatment because it is less invasive and can preserve fertility. However, surgical intervention is available for women for whom medical therapy fails or who have a high burden of disease.

Case History

According to history, a 26-year-old woman presented to the emergency department with an episode of coughing up blood. During the previous 4 years, she had had intermittent episodes of small-volume hemoptysis coinciding with her menstrual cycles. She had no other abdominal or pelvic symptoms. Her oxygen saturation was 100% while she was breathing ambient air. On physical examination, the lungs were clear. Noncontrast computed tomography (CT) of the chest on the third day of her menstrual cycle showed an 11-mm ground-glass, cavitary nodule in the right lower lobe (Panel A, arrow). A video-assisted thoracoscopic wedge resection was performed, and a reddish-brown lesion was identified. Histopathological analysis revealed endometrial glands and stroma (Panel B), which confirmed a diagnosis of thoracic endometriosis. Catamenial hemoptysis is a rare manifestation of thoracic endometriosis, and both CT and histopathological examination are important for diagnosis. At a follow-up visit 2 years after resection, the patient was symptom-free.

For further reference, log on to: New England Journal of Medicine